NPIMap

Organization Active NPI

Tattnall Hospital Company LLC

  • Neurological Surgery Physician
  • Rincon, GA
National Provider Identifier
1487439832
Registry record updated Jan 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
TATTNALL HOSPITAL COMPANY LLC
Practice address
810 Towne Park Dr Ste 200
Rincon, GA 31326-5167
Phone
(912) 721-8145
NPI assigned
Aug 25, 2023
Organization subpart
Yes
Parent organization
TATTNALL HOSPITAL COMPANY LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 8, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David Alex Villa
Title
Ceo
Phone
(912) 629-7797

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207T00000X Primary
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X
Pain Medicine (Psychiatry & Neurology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P2900X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0000X

Addresses

Primary practice location

810 Towne Park Dr Ste 200
Rincon, GA 31326-5167

Mailing address

440 Mall Blvd Ste C
Savannah, GA 31406-4868
Phone (912) 644-3340

Other names 1

  • OPTIM MEDICAL CENTER TATTNALL RINCON Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080915000167 GA Part B Supplier - Clinic/Group Practice 6204907124 Receives reassigned benefits from 63 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Reidsville, GA; Swainsboro, GA; Richmond Hill, GA; Rincon, GA; Sandersville, GA; Savannah, GA; Statesboro, GA; Sylvania, GA…

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2290870Optim Medical Center Tattnall-Rincon810 Towne Park Drive, Suite 200, Rincon, GA 31326Certificate of waiverOct 2, 2027

National Provider Directory

National Provider Directory
Tax ID family
Coastal Imaging21 organizations share this tax ID, including this one
Part of
Coastal Imaging

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

Locations

790 Veterans Parkway
Ste 111
Hinesville, GA 31313
Phone (912) 368-3868

209 Mims Rd
#A
Sylvania, GA 30467
Phone (912) 564-5236

102 Rocky Ford Rd
Sylvania, GA 30467
Phone (912) 564-2155

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1692921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767830400000",
    "number": "1487439832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 MALL BLVD STE C",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314064868",
            "telephone_number": "912-644-3340",
            "fax_number": "912-644-5398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 TOWNE PARK DR STE 200",
            "city": "RINCON",
            "state": "GA",
            "postal_code": "313265167",
            "telephone_number": "912-721-8145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TATTNALL HOSPITAL COMPANY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TATTNALL HOSPITAL COMPANY LLC",
        "enumeration_date": "2023-08-25",
        "last_updated": "2026-01-08",
        "certification_date": "2026-01-08",
        "status": "A",
        "authorized_official_last_name": "VILLA",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "ALEX",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "912-629-7797"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OPTIM MEDICAL CENTER TATTNALL RINCON",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rincon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.